Abstract 12511: Efficacy of Bivalirudin versus Heparin Use on Clinical Outcomes Post Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials

Background: For patients undergoing percutaneous coronary intervention (PCI), Bivalirudin has been shown to reduce major bleeding, however, unfractionated heparin is currently considered the standard of care. Objective: We sought to perform an updated meta-analysis comparing the efficacy of bivalirudin versus heparin undergoing PCI with the inclusion of the most recently published trials. Methods: A systematic literature search was performed in PubMed, Embase, and Clinicaltrial.gov from inception to 10th May 2023 for studies comparing bivalirudin vs. heparin among PCI-undergoing patients. Pooled odds ratios (OR) were calculated using a random effect model, and a p-value of <0.05 was considered statistically significant. Results: A total of 14 randomized controlled trials with 35,533 patients (17765 in Bivalirudin treated group and 17768 patients in Heparin treated group). The pooled analysis shows that bivalirudin was associated with significant 21% reduction in net adverse clinical events (NACE) (OR, 0.79(95%CI: 0.71-0.88), P<0.01), cardiovascular mortality (CVM) by 24% (OR, 0.76(95%CI: 0.65-0.90), P<0.01), major bleeding by 36% (OR, 0.64(95%CI: 0.49-0.83), P<0.01), transfusion by 42% (OR, 0.58(95%CI: 0.44-0.77), P<0.01) compared to heparin. There was a trend of reduced all-cause mortality among bivalirudin groups (OR, 0.86(95%CI: 0.72-1.02) compared to the heparin group of patients, however, it didn't reach statistical significance. Incidence of stroke, major adverse cardiovascular events, myocardial infarction, and stent thrombosis was comparable between both groups of patients. Conclusion: Bivalirudin has shown to be superior to heparin among patients undergoing PCI with a reduction in bleeding, CVM, NACE, and a trend of reduced all-cause mortality.